HomeMy WebLinkAboutMortgage_Hartsburg"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C n 7owri ip ear
_ FOR DEDUCTION FROM ASSESSED VALUATION �
� . SfdIB Fortn C37D9 (R71 / fr09)
�' Fresaieee by Depefbnent of Local Govemrnem FuiarKe
wsrnucnoNS: AUI�'�g�"�`�010
To be �led in rson or b mail wiN the Coun Auditor or Coun RecoNer of the coun where the F� �� ��
Pe Y �Y b h P�PertY is rocated.
Filirg Dates: 7J Real Property: Must file dwng the year /or which the deduction is sought. G� ,�q� p,uditor
2) Mo6de / Manulactured Homes not assessed as Real Pioperty Must file dunng fhe hveNe (12) monNs
belore March 37 of each year Ne deduclion a sou�ht R��
GIBSO C�TY AU ITOR
See raverse side for additional inshuctnons and qual'dicatbns.
Ci/ ✓ /.-�' • / CJt/v`�.l�cr`^�
Ta�dng Disbict Key mimba / al desaiption
-/ -/ - �OD
Ase�sed rahie dmal pmp as of Mortga9e / Canbayce�[ i/rdrbteCr�s unpaid as of
MerU 1. al'art ym Memh 7. cv 1 J O
Q �
u ro, what Ls ns � ner ezaC sare or intrlesn
If n2m0 qt Rmd'4
rtumpgee «
,—.•-'-�i
sbcel, �y, sbte, ard LP mde)
ol assignee v oiTU awner or halder o( mortgage
PdEress ot ass'sp�m (number ane street rny, stete, end
oces epyimN wm PAO«lr in any omc
munty in Ind'aru7 r-� . _
Pi�7
Si9�atlne
�L�
I I We certify under�fie penalry oi
owner / mntract buyer of Ne a(on
aW�d bY E�N execute0
20 _
p aewrd numbrl
�/Sp -00 ) a.D(D
Mongape / Cantraa cWebtedness im7� as d I
Cate of aOP�'ation I
tt ownad riN somearre oNer than spouse.
couNrrnuortaa
r.�
v� u No
perty in GuesGOn: MmuDY Assessed
a�oaenv ❑ rvmuairya�s�ea
Dra»•er NO. �Ql.b
Card i\'O. ...a51 �
.............
� �5, a00. °O
20_ 20_ 20_
Y��
ihe above and foregoing information is true and correct and Nat Me appGrant is a resideM of IMiana and
P�PenY on date aPWication is filed.
Date (rtmfh. deY. Yea�
Mtltas ot auNal�C person (numoer arN stree4 �Y. ��. e^�
� . �- - —_
142�J
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Date (rnorvh. tlay yee�